Journal of gerontological nursing最新文献

Purpose: Promotion and maintenance of healthy aging is of utmost importance given the growing number of older adults worldwide. Fluctuation in intrinsic capacity (IC), defined as mental and physical functions, can be assessed objectively with an assigned score to predict health outcomes. The goal of the current review was to identify common measurement tools for IC assessment and evaluate IC scoring approaches.

Method: Seventeen studies met inclusion criteria for assessing five domains: vitality, locomotion, cognitive, psychological, and sensory.

Results: Reviewed studies used diverse instruments with inconsistent scoring approaches. Scoring ranged from simple additive scores to complex item response theory models.

Conclusion: Establishing consistency in assessment and scoring for IC will ensure usability of scores in clinical practice to promote healthy aging and identify older adults at risk for disability or care dependence. Additional research is needed to establish consensus in standardized scoring, assessment, and measurement of IC. [Journal of Gerontological Nursing, 51(7), 25-33.].

Purpose: To determine if implementation of a dementia-specific advance care planning (ACP) tool increased knowledge of dementia and decision maker confidence and decreased inappropriate health care utilization rates.

Method: At a Program for All-Inclusive Care for the Elderly, individuals with a cognitive deficit (CD) and their surrogate decision makers (SDMs) were recruited as dyads in an ACP pilot program using a dementia-specific ACP tool. Knowledge was assessed for both dyad members and confidence regarding their role was assessed for SDMs, repeated at 3 months.

Results: Individuals with CD showed no increase in dementia knowledge scores; however, SDMs showed improvement in knowledge and confidence. Health care utilization rates decreased by five visits.

Conclusion: Findings suggest that the terminality of dementia may be misunderstood. Timely implementation of a dementia-specific ACP may resolve ambiguity, allowing for discussion regarding care preferences. [Journal of Gerontological Nursing, 51(7), 43-48.].

Purpose: Xanomeline/trospium, a combination of a mixed muscarinic agonist/peripheral antagonist, is a novel treatment for schizophrenia that does not antagonize dopamine receptors. Given its unique pharmacology on the cholinergic system, special considerations may apply for older adults.

Method: The current article reviews the evidence of xanomeline/trospium in older adults as well as implications and considerations for use in practice.

Results: The evidence of using xanomeline/trospium is largely derived from the phase-3 EMERGENT clinical trial program, which investigated safety and efficacy in adults aged 18 to 65 years with schizophrenia. Significant reduction in psychosis was demonstrated; however, gastrointestinal effects were common.

Conclusion: Xanomeline/trospium is a novel treatment for schizophrenia that lacks many of the adverse effects associated with dopamine receptor blockers. Although the package insert provides guidance for use in older adults, patients aged >65 years were excluded from EMERGENT trials. Continued research is necessary to define the safety and place in therapy for older adults. [Journal of Gerontological Nursing, 51(6), 7-12.].

Purpose: To explore the relationship between social isolation and psychological well-being among community-dwelling older adults and analyze the mediating role of physical activity and psychological resilience in the chain mediation effect between social isolation and psychological well-being.

Method: Two hundred sixty-five older adults from six communities in Baoding City were selected using convenience sampling. Social isolation, physical activity, psychological resilience, and psychological well-being were measured. The SPSS PROCESS program was used to test the chain mediation effect.

Results: Pearson correlation analysis indicated significant relationships between psychological well-being and social isolation, psychological resilience, and physical activity (all p < 0.001). Mediation analysis results showed that social isolation directly affects psychological well-being and influences psychological well-being through three mediation chains: physical activity, psychological resilience, and the chain mediation effect of physical activity and psychological resilience. Total mediation effect accounted for 60% of the total effect.

Conclusion: Social isolation is a significant risk factor for decreased psychological well-being among older adults, and physical activity and psychological resilience serve as important explanatory mechanisms. Community health workers should prioritize the impact of social isolation on the psychological well-being of older adults and develop intervention strategies based on the pathways of physical activity and psychological resilience to enhance psychological well-being and promote healthy aging. [Journal of Gerontological Nursing, 51(6), 23-29.].

Purpose: To determine factors associated with emergency department (ED) visits or hospitalizations among older adults with urinary incontinence (UI) in home health care (HHC).

Method: We analyzed HHC episode data for adults aged ≥65 years with UI. Five clusters were identified a priori using hierarchical clustering of symptoms extracted from clinical notes using natural language processing. Chi-square tests and backward stepwise logistic regression identified cluster, sociodemographic, and clinical variables associated with outcomes.

Results: A total of 39,179 HHC episodes reflecting 29,981 patients were included. Episodes in the anxiety, all symptoms, dizziness-anxiety, and constipation-anxiety-dizziness clusters were more likely to result in ED visits/hospitalizations versus the no symptoms cluster. Episodes for Black and Hispanic patients had higher odds of these outcomes than White patients. Episodes for patients with skin ulcers and prior urinary tract infections had higher odds of these outcomes than those without these characteristics.

Conclusion: Older adults with UI require comprehensive care addressing complex factors contributing to ED visits/hospitalizations. [Journal of Gerontological Nursing, 51(6), 38-47.].

Purpose: To explore the association between adverse childhood experiences (ACEs) and care-related strain among spouses of persons living with dementia (PLWD).

Method: Data from spouses (N = 30) of PLWD were included in a cross-sectional analysis examining whether childhood adversity, as measured by the Adverse Childhood Experiences Questionnaire (ACE-10), was associated with reports of care-related strain, as measured by the Zarit Burden Interview (ZBI-12).

Results: Care-related strain was moderate (mean = 17), and there was a significant difference between ZBI-12 scores of spouses with no ACEs (n = 10, mean = 11.3) versus those with ≥1 ACE (n = 18, mean = 20.17) (p = 0.01, 95% confidence interval [-15.37, -2.36]). Multiple linear regression analysis indicated there was a significant association between ACE-10 and ZBI-12 scores (p = 0.006), even when controlling for role captivity (p < 0.001).

Conclusion: ACEs may influence the degree of care-related strain experienced by spouses of PLWD based on these preliminary results. Future research is needed to understand mechanisms and potential interventions for heightened appraisal of strain among spousal caregivers with ACEs. [Journal of Gerontological Nursing, 51(6), 17-21.].

Purpose: To describe the perspectives of lower socioeconomic status (SES) former family caregivers of Black persons living with dementia (PLWD) on advance care planning needs and preferences for their care recipients.

Method: Semi-structured interviews were completed with 17 lower SES former family caregivers of Black PLWD. Basic qualitative description was used for these analyses.

Results: Four major themes were identified: (1) Improvements Needed for Caregiver Education, (2) Caregiver Support Needs During and After Caregiving, (3) Obstacles Faced During Caregiving, and (4) Need for Restored Identity Following Care Recipient Death. Former family caregivers also expressed a desire to support current caregivers.

Conclusion: Findings fill a critical gap in the literature by highlighting challenges faced during and after caregiving. Future research should leverage perspectives of former caregivers to assist with improving outcomes for Black caregivers, thereby promoting health equity. [Journal of Gerontological Nursing, 51(6), 30-37.].

Purpose: To determine the prevalence of frailty among individuals aged ≥65 years with heart failure and/or chronic obstructive pulmonary disease, and if there was a difference in length of stay (LOS) and/or discharge disposition in individuals who mobilized daily versus those who did not.

Method: Thirty-five individuals were screened using the FRAIL Scale. A retrospective chart review was performed for participants with frailty, assessing residential location on admission and discharge, LOS, and daily mobilization during hospitalization.

Results: Participants were categorized as robust (n = 1, 2.9%), pre-frail (n = 15, 42.9%), and frail (n = 19, 54.3%). Mean LOS for those who mobilized daily (n = 12) was 2.33 and 4.71 for those who did not mobilize daily (p = 0.028). A lower percentage of participants who mobilized (16.7%) required higher levels of care at discharge versus those who did not mobilize (42.9%, p = 0.067).

Conclusion: Early recognition of frailty may provide opportunities to implement mobility programs to decrease LOS and ensure these individuals remain at functional baseline. [Journal of Gerontological Nursing, 51(6), 13-16.].